Acquired laryngomalacia as a cause of post-extubation respiratory failure in patient with postoperative seizure and central pontine myelinolysis after craniotomy

Akimoto, Yusuke; Bando, Natsuki; Sato, Hiroki; Sato, K.; Momota, Kazuki; Nunomura, Toshiyuki; Ueno, Yoshio; Ishihara, Manabu; Tane, Natsuki; Itagaki, Taiga; Oto, Jun

doi:10.2152/jmi.69.316

Cited by 3 publications

(8 citation statements)

References 18 publications

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“…A total of 33 studies were included in our review 9‐11,19‐48 . A PRISMA diagram outlining our search is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…All patients demonstrated some supraglottic involvement that was suspected to contribute to symptoms, although there was considerable diversity in the clinical presentation of included patients. A total of 16 patients from 6 studies were suspected to develop symptoms after neurological compromise 10,19,23,39,42,47 . Five of these studies mention the term laryngomalacia, ALM, or “acquired” laryngomalacia to describe their patients or refer to this term throughout the article 10,19,23,29,47 .…”

Section: Resultsmentioning

confidence: 99%

“…On our review, the stridor was identified as various supraglottic structures that were vibrating or collapsing into the laryngeal inlet during inspiration, whether it was the epiglottis (79.7%), supraglottic structures (arytenoids, mucosa) at symptoms in some cases. Types of neurologic injury leading to ALM include central pontine myelinolysis after craniotomy, 19 head trauma, 10,23,42,47 neurodegenerative disease, 39,47 drug and alcohol overdose with coma, 42 bleeding aneurysm, 10 and brain stem stroke. 10 Most of these patients had flaccid epiglottis on exam, and 6 received epiglottectomy (Table 1) with improvement in symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…While the etiology of ALM is challenging in many cases, we do see a pattern of neurological injury leading to symptoms in some cases. Types of neurologic injury leading to ALM include central pontine myelinolysis after craniotomy, 19 head trauma, 10,23,42,47 neurodegenerative disease, 39,47 drug and alcohol overdose with coma, 42 bleeding aneurysm, 10 and brain stem stroke 10 . Most of these patients had flaccid epiglottis on exam, and 6 received epiglottectomy (Table 1) with improvement in symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…10,19,23,39,42,47 Five of these studies mention the term laryngomalacia, ALM, or "acquired" laryngomalacia to describe their patients or refer to this term throughout the article. 10,19,23,29,47 One study mentions the similarity of the patient presentation to congenital laryngomalacia, although describes the symptoms as a distinct entity as "acquired" and does not use the specific term of laryngomalacia. 42 There were 24 patients from 6 studies whose symptoms were induced by exercise.…”

Section: Heterogeneity Of Included Patientsmentioning

confidence: 99%

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Adult Laryngomalacia: A Scoping Review

Mills,

Monaghan,

Nguyen

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveThis review sought to determine the characteristics of adults diagnosed with new onset laryngomalacia including airway symptoms, laryngoscopic findings, treatments, and outcomes. Moreover, we wanted to highlight suspected limitations in the literature.Data SourcesStudies were identified through CINAHL, Cochrane Review, PubMed, and Scopus published between 1966 and 2023.Review MethodsThe search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analysis Extension for Scoping Reviews checklist by 2 independent investigators. A meta‐analysis of proportions and continuous measures was conducted.ResultsOf the 1121 abstracts identified, 33 articles pertaining to laryngomalacia in the adult population were included. The most common presenting symptoms were stridor at rest (78.3%, 65.1‐88.3) and dyspnea with exertion (83.8%, 64.8‐96.3). The most suspected etiology was exercise‐induced (86.0%, 69.4‐95.5), and the most common description of laryngomalacia on visualization was collapse of supraglottic structures during exercise (93.3%, 79.0‐99.1). Nonsurgical options were attempted in 87.0% (54.0‐99.1), which included oral appliances, respiratory retraining, breathing techniques, and working with a speech pathologist. Surgical options were ultimately performed in 84.2% (75.0‐91.0). Complete resolution of symptoms following therapy was seen in 61.9% (48.0‐74.6).ConclusionAdult onset laryngomalacia is difficult to characterize. It typically presents in patients during exercise, with neurological injury, or idiopathically. Surgical management can lead to improvement or complete resolution of symptoms. The need for a universal nomenclature is highlighted in this review, as it is inconsistently classified.

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“…A total of 33 studies were included in our review 9‐11,19‐48 . A PRISMA diagram outlining our search is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Heterogeneity Of Included Patientsmentioning

confidence: 99%

See 3 more Smart Citations

Adult Laryngomalacia: A Scoping Review

Mills,

Monaghan,

Nguyen

et al. 2024

Otolaryngol.--head neck surg.

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Acquired laryngomalacia as a cause of post-extubation stridor and extubation failure following craniotomy: a case report

et al. 2023

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Background Laryngomalacia is a dynamic airway condition characterized by flaccid laryngeal tissue and inward collapse of supraglottic structures during inspiration. Although it may cause airway obstruction and requires careful management, there have been few reports regarding laryngomalacia after surgery. We report a case of adult-onset laryngomalacia occurred after craniotomy requiring reintubation. Case presentation A 21-year-old man was admitted to the ICU after craniotomy for a cerebellopontine angle tumor. He developed severe stridor immediately after extubation on the postoperative day 2 and required reintubation. On the postoperative day 5, similar episode occurred following re-extubation and fiberoptic laryngoscopy revealed a collapsed epiglottis and left arytenoid into the glottis. A diagnosis of laryngomalacia was made, and he underwent tracheostomy. Laryngomalacia had completely improved; however, bilateral vocal cord paralysis was detected 2 weeks later. Conclusions Acquired laryngomalacia should be considered as a possible mechanism of the airway symptoms in a patient with neurological dysfunction.

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Repetitive postoperative extubation failure due to dynamic inspiratory airway collapse concomitant with subglottic stenosis in a patient who previously underwent tracheostomy.

et al. 2023

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Background : This report describes a case of dynamic inspiratory airway collapse concomitant with subglottic stenosis in a patient who previously underwent tracheostomy that led to repeated post-operative extubation failure. Case presentation : A 43-year-old woman who had undergone tracheostomy 25 years previously was admitted to our intensive-care unit (ICU) after coronary artery bypass graft surgery. On postoperative day (POD) 0, she was extubated, but stridor was observed. We suspected upper airway obstruction and she was therefore reintubated. Before reintubation, urgent laryngotracheoscopy revealed dynamic inspiratory airway collapse and obstruction concomitant with subglottic stenosis. Preoperative computed tomography showed mild subglottic stenosis. Although intravenous corticosteroids were administered to prevent tracheal mucosal edema and a cuff leak test was confirmed to be negative, she developed extubation failure on POD6. On POD12, we performed tracheostomy to reduce mechanical irritation from the endotracheal tube. Mechanical ventilation was withdrawn and she discharged from the ICU. On POD33, her tracheostomy tube was removed and she remained clinically asymptomatic. Conclusions : We should be aware of the history of tracheostomy, especially at high tracheostomy sites, even in the absence of respiratory symptoms as risk factors for dynamic inspiratory airway collapse concomitant with subglottic stenosis contributing to repeated respiratory failure after extubation.

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Acquired laryngomalacia as a cause of post-extubation respiratory failure in patient with postoperative seizure and central pontine myelinolysis after craniotomy

Cited by 3 publications

References 18 publications

Adult Laryngomalacia: A Scoping Review

Adult Laryngomalacia: A Scoping Review

Acquired laryngomalacia as a cause of post-extubation stridor and extubation failure following craniotomy: a case report

Repetitive postoperative extubation failure due to dynamic inspiratory airway collapse concomitant with subglottic stenosis in a patient who previously underwent tracheostomy.

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